Eric TopolMD · cardiologist · Executive Vice President, Scripps Research
No. Chase fitness, not that number. The mortality evidence everyone cites measured something else, and your watch cannot measure this one.
What it rests onA claim about what the published cohorts actually measured, plus a measurement-validity argument about consumer devices. He names his opponent and calls the assertion false in print.
Source: erictopol.substack.com ↗
Peter AttiaMD · longevity physician, founder of Early Medical
Yes. Get out of the bottom quartile, then aim for the elite band for your age and sex.
What it rests onThe same observational cohorts Topol cites, read as an argument for the individual to raise the measure. He is explicit that the underlying study is observational.
Source: peterattiamd.com ↗
Topol is writing for a general reader who owns a smartwatch and has probably never had a metabolic cart test, and his practical target is someone in the bottom half of the fitness distribution. Attia is writing for someone already training, with the money and inclination to buy a lab test, and his elite-band target is explicitly about the top few percent. The advice diverges least for the person both are trying to move off the bottom rung.
Both hold that cardiorespiratory fitness is among the strongest predictors of all-cause mortality available, and both cite the same Mandsager cohort of 122,000 patients to say so. Both accept the evidence is observational. Neither disputes that hard aerobic training improves fitness. The fight is over the measurement and over what an individual should aim at, not over whether fitness matters.
A large prospective study measuring true VO2 max by metabolic cart, at the scale of the existing cardiorespiratory fitness cohorts, would settle whether the extrapolation Topol objects to is safe. Independent validation of wearable VO2 max estimates against laboratory measurement would settle the second half of his objection, which is about the device rather than the physiology.
You do, and your call is dated, kept, and yours to change. Follow the people you already trust and what they publish turns into a short daily practice.
Free to sign up and use. We do not ask for a card.